Gastroduodenal Lesions In Patients Research Articles

Bowel Cleansing Preparations Are Associated with Gastroduodenal Lesions

Background: During esophagogastroduodenoscopy performed with colonoscopy, gastric and duodenal erythema, erosions, and ulcerations are often observed. This investigation was designed to review the prevalence of gastroduodenal lesions in patients who have undergone wireless capsule endoscopy using standard bowel cleansing preparations, but no endoscopy or sedation. Methods: A retrospective analysis was conducted on patients referred for capsule endoscopy. Records and capsule reports were reviewed for the patient demographics, preparation prescribed, procedural indications, and gastroduodenal findings. The preparations studied included polyethylene glycol lavage (PEG), PEG plus bisacodyl (PEG + bis), bisacodyl (bis), oral sulfate solution (OSS), and no prep. Results: Among the 1236 records, 498 (40.3%) were men and 738 (59.7%) were women. The mean age was 56 years +/− 18 years SD. The percentage of patients with lesions after any bowel preparation was 52.7% for gastric lesions and 23.6% for duodenal lesions. The percentage of patients with gastroduodenal lesions was 58.3% with prep, compared to 38.2% without prep. These findings were statistically significant, with an RR of 1.53 [1.19–1.94] (p-value = 0.00004). This difference was more pronounced in the OSS group RR of 1.65 [1.29–2.1] and bisacodyl group RR of 1.64 [1.25–2.15] compared to the PEG group RR of 0.95 [0.7–1.3]. Conclusions: This study showed that patients undergoing wireless capsule endoscopy who received bowel preparations had a significant increase in gastric and duodenal lesions. Of the preparations studied, OSS was associated with a greater number of gastroduodenal lesions, while PEG was the least associated with lesions, with an occurrence similar to the non-prep group. The clinical significance of these lesions remains undetermined. Endoscopists should be aware that preparations are associated with gastroduodenal lesions to avoid the misinterpretation and misdiagnosis of these lesions.

Aspirin-induced gastrointestinal lesions in patients with chronic coronary artery disease: special aspects and therapeutic options

Aim. To assess the prevalence, structure, and features of aspirin-induced gastroduodenal lesions in patients with chronic coronary artery disease (CAD) and outline therapeutic options. Material and methods . The study included 340 patients with chronic CAD who received long-term low-dose acetylsalicylic acid (ASA) therapy. The diagnosis of chronic CAD was verified using a complex examination with selective coronary angiography (SCA). Further, esophagogastroduodenoscopy was performed in patients with chronic CAD to diagnose aspirin-induced gastroduodenal lesions. We also assessed their prevalence and structure. An endogenous prostaglandin-inducer rebamipide (300 mg daily) in combination with a proton pump inhibitor (PPI) pantoprazole were used to treat aspirin-induced gastroduodenal lesions. The comparison group consisted of patients with chronic CAD who received only pantoprazole. To clarify the pathogenesis of aspirin-induced gastroduodenal lesions before and after treatment, the levels of following serum pro-inflammatory cytokines were determined: interleukin-6 (IL-6), interleukin-1-beta (IL-1β), tumor necrosis factor alpha (TNF-α). The control group consisted of patients with chronic CAD and without signs of gastrointestinal lesions. Statistical processing was carried out using Statistica 10.0 software package. Results . Aspirin-induced gastroduodenal lesions were recorded in 15% of patients. Results of esophagogastroduodenoscopy revealed that gastric erosions of body and antrum prevailed among aspirin-induced lesions. The level of pro-inflammatory cytokines in these patients was significantly higher than in patients of control group. Therapy with PPI resulted in a positive endoscopic response in 19 of 25 patients and a slight decrease in cytokines. Combination of PPI with rebamipide led to mucosal reconstruction in all subjects and a statistically significant decrease in levels of serum pro-inflammatory cytokines. Conclusion. The current study showed aspects of development and possible therapeutic options in aspirin-induced gastrointestinal lesions in patients with chronic CAD.

The prevalence of acute erosive-ulcerative gastroduodenal lesions in patients with cardiovascular diseases, taking anticoagulants and antiplatelet agents

Aims: to draw attention to the lack of recommendations for the prevention and treatment of acute erosive-ulcerative gastroduodenal lesions and their complications associated with the severity of the patient’s condition, the massiveness of antiplatelet and anticoagulant therapy and the degree of risk of bleeding.Materials and methods: a literature review was conducted of domestic and foreign authors on the problem of pathogenesis, clinical manifestations, diagnosis, treatment and prevention of lesions of the upper gastrointestinal tract in cardiovascular diseases.Results: there are no standardized recommendations for the prevention and treatment of OEGP and their complications, taking into account the individual characteristics of the patient, based on evidence.Conclusion: it is necessary to develop a scale that assesses the risk of OEGP and gastrointestinal bleeding in cardiovascular diseases, methods of treatment and prevention of these conditions, taking into account the specific parameters of the patient.

Helicobacter pylori infection and gastroduodenal lesions in patients with systemic lupus erythematosus.

The aim of this study was to determine the frequency of Helicobacter pylori in SLE patients and to compare clinical characteristics and gastroduodenal lesions in patients with and without H. pylori infection. Adult SLE patients were selected and subjected to endoscopy. Gastroduodenal lesions were examined by endoscopy and biopsy (antrum and corpus). Biopsies were evaluated by hematoxylin and eosin and Giemsa staining. Immunochromatographic membrane-based assay using amplification was used to test for H. pylori antigen (coproantigen) in stool samples in all participants. Clinical characteristics and gastroduodenal lesions were compared between patients with and without H. pylori infection. A total of 118 SLE patients were included (mean age 44.7 ± 11.7 years, mean disease duration 11.6 ± 6.0 years), of whom 101 (85.6%) were receiving non-steroidal anti-inflammatory drugs (NSAIDs). The coproantigen test was positive in 32 (27.1%) patients. H. pylori was present in twenty six patients (22.0%) in the gastric biopsy. The frequency of gastric erosions and gastric ulcers were 55.1% and 0.8%, respectively. Gastric erosions were less frequent in SLE patients with H. pylori infection than those without H. pylori (43.5.7% vs. 62.5%; p = 0.04). The age, disease duration, disease activity, chronic damage, gastroprotective drugs, and immunosuppressive therapy did not differ between the two groups. We found a high frequency of H. pylori infection in SLE patients. The severity of SLE and reception of gastroprotective therapy do not seem to be related to H. pylori infection. Immunosuppressive therapy may not be protective against H. pylori infection in SLE patients.Key Points• In patients with systemic lupus erythematosus (SLE), the frequency of Helicobacter pylori infection was 39% and gastric erosions were frequent.• Disease activity, chronic damage, gastroprotective drugs, and immunosuppressive therapy may not affect the prevalence of H. pylori infection in SLE patients.

The contribution of clinical and pathological predisposing factors to severe gastro-duodenal lesions in patients with long-term low-dose aspirin and proton pump inhibitor therapy

BackgroundPreventive strategies developed to avoid the complications of antiplatelet therapies recommend the evaluation of risk factors for gastrointestinal events and indicated gastroprotective strategies. AimWe aimed to assess the impact of predisposing factors - histological findings, concomitant drug consumption, comorbidities, symptoms, social habits, Helicobacter pylori infection - on severe gastro-duodenal lesions in patients with low-dose aspirin and concomitant protective therapy with proton pump inhibitors (PPI). MethodWe enrolled 237 patients with LDA and PPI therapy, referred for upper digestive endoscopy, divided into two groups according to the severity of their endoscopic lesions (172 patients with no or mild endoscopic lesions and 65 patients with severe endoscopic lesions). ResultsIn the univariate logistic regression model, the factors associated with severe gastro-duodenal lesions were gender (OR=1.87, 95% CI: 1.04–3.41), anticoagulants (OR=2.40, 95% CI: 1.26–4.53), gastric atrophy and/or intestinal metaplasia (OR=1.85, 95% CI: 1.04–3.32), congestive heart failure (OR=2.59, 95% CI: 1.16–6.62), anaemia (OR=3.01, 95% CI: 1.67–5.47) and smoking (OR=4.29, 95% CI: 1.57–12.32). In the final model, anticoagulants (p=0.041<0.05) and anaemia (p=0.019<0.05) were risk factors for severe lesions via multivariate regression analysis, while for active/inactive chronic gastritis and smoking a positive dependency with a tendency towards statistical significance (p<0.10) was noticed for severe gastric lesions. ConclusionsIn patients treated with low-dose aspirin and gastroprotective therapy with proton pump inhibitors we have enough evidence to consider co-treatment with anticoagulants and anaemia important predictors for severe endoscopic lesions, while other factors such as inflammation in gastric biopsies, congestive heart failure, co-treatment with clopidogrel and smoking tended to have a positive influence on risk for severe gastro-duodenal lesions.

Endoscopic Evaluation by Lanza Score of The Upper Gastrointestinal Bleeding in Patients Under Long-term Low-dose Aspirin for The Prevention of Cardiovascular Events

introduction: low dose aspirin is widelybused for the prevention of cardiovascular events but despite its beneficial effects, it can generate more or less serious digestive disorders. the aim of this study was to evaluate endoscopically by the lanza score the gastroduodenallesions in patients on long dose aspirin with upper gastrointestinal bleeding Materials and methods and result: Among 2135 cases of UGB admitted to emergency departments in the same period, 134 cases occured in patients with low dose aspirin average age: 65.3+/- 24.7 years, sex ratio: 2.3 F/ M. At endoscopic examination: bulbar ulcer in 44/134 (32.9%), antral ulcer in 39/134 (29%) and erosive bulbar duodenitis in 29/134 (21.6%). Stages 3 and 4 of the lanza classification were observed in n95/134 (71%). Conclusion: In this work, women over 65 are the most concerned. bulbar and antral ulcers are the most frequent lesions, and stages 3 and 4 are the most frequent of the lanza score.

Evaluation of the Development of Gastroduodenal Lesions in Patients Treated with Low-dose Aspirin or Non-steroidal Anti-inflammatory Drugs

Aspirin irreversibly inhibits the enzyme cyclooxygenase-1 and depresses the production of thromboxane A(2), and also exerts antiplatelet effects. On the other hand, it also depresses the production of prostaglandin E(2) (PGE(2)) and induces gastroduodenal lesions, which are often seen in patients taking aspirin. The aim of this study was to clarify the degree of gastroduodenal lesions induced by low-dose aspirin. We investigated the incidence rate of such lesions induced by aspirin and non-steroidal anti-inflammatory drugs (NSAIDs), and performed theoretical evaluations in a retrospective study. The incidence rates of gastroduodenal lesions in the low-dose aspirin (n=1103) and NSAIDs (n=1856) groups were 2.54% and 0.27%, respectively, which was significantly greater in the aspirin group. Furthermore, the calculated value of inhibition rate of gastric PGE(2) was significantly correlated with the actual value after administration of aspirin or NSAIDs (r=0.902, p<0.05), which suggested that the calculated value reflected the actual value. The calculated value of aspirin (98.9%) was higher than that of NSAIDs (3.67-70.8%) after administration of the drugs with the standard doses. Our findings indicate that the incidence rate of gastroduodenal lesions induced by low-dose aspirin was higher than that of those induced by NSAIDs. Therefore, we were able to perform a theoretical evaluation of the occurrence of gastroduodenal lesions.

Associação entre lesões da mucosa gastroduodenal e Helicobacter Pylori em pacientes com doença hepática crônica

The relationship between Helicobacter pylori infection and gastroduodenal lesions in chronic liver disease remains controversial. Evaluate the evidence of the role of H. pylori infection in gastroduodenal lesions in patients with chronic liver disease. Forty-six patients with chronic liver disease were matched with 27 dyspeptic persons for age and sex. The gastroduodenal lesions were portal hypertension gastropathy, erosion and peptic ulcer. All patients underwent upper endoscopy: two biopsies were taken in the antrum and in the gastric body. The biopsies were used for Giemsa staining. A gastroduodenal lesions were found in 38 (82.6%) patients with liver disease and was significantly more frequent than among controls (P = 0.002). H. pylori infection was detected at histological assessment in 13 (28.2%) patients with chronic liver disease and in 17 (62.9%) controls. The odds ratio (OR) showed an interaction statistically significant between gastroduodenal lesions and chronic liver disease (P = 0.04; OR = 5.1; 95% CI = 1.6-17.3). When adjusted for the presence of H. pylori OR was significantly with H. pylori negative (OR 13.0 IC 95%, 1.4-327.9). Patients with chronic liver disease showed higher risk of developing gastroduodenal lesions regardless of the presence of the H. pylori infection.

W2023 Endoscopic Visible Light Spectroscopy: A New Minimally Invasive Technique for the Diagnosis of Chronic Gastrointestinal Ischemia

Background Upper gastrointestinal endoscopy is often used as diagnostic method for chronic gastrointestinal ischemia (CGI). This is based on the assumption that patients with symptomatic CGI have typical gastroduodenal abnormalities like erosions/ulcerations and/or paleness. However, little is known about the true prevalence and character of specific gastroduodenal lesions in patients with CGI. This study therefore aimed to investigate upper endoscopic findings in patients with well-defined CGI. Methods Prospectively, consecutive patients suspected for CGI were included. All patients underwent a standard diagnostic work-up existing of gastroduodenoscopy, gastric and jejunal 24 hour tonometry (TM) enabling mucosal CO2measurements both in fasting and post-prandial state, and CT or MR abdominal angiography for defining abdominal arterial stenosis. All diagnostic results were discussed in a multidisciplinary team and a consensus diagnosis on presence or absence of CGI was made. Only patients diagnosed with CGI were included for this study. Endoscopic findings were scored in the stomach, bulbus, and duodenum. They were differentiated in mucosal erythema, edema, paleness, and breaks (erosions/ulcers). Results In 2 years time, 144 patients were analyzed for possible CGI. CGI was diagnosed in 76 patients (53%): 25 males, mean age 62 (17-86) years. Singleand multivessel disease was diagnosed in 43 and 33 patients respectively. Upper endoscopy was performed in 55 patients. Endoscopic pathological findings were found in 34 (62%) of those 55 patients (Table). Typical ischemic lesions (erosions/ ulcerative lesions and/or paleness) were only found in 19 (25%) patients. Mucosal erythema and edema were found most frequently, and were mostly seen in the stomach, in 22 and 13 patients respectively. Conclusions CGI patients often present with non-specific upper endoscopic pathology, only a minority of patients show mucosal breaks and/or paleness during upper gastrointestinal endoscopy. No differences in prevalence and character of pathological findings existed between patients with single versus multiple vessel CGI. These data show that normal endoscopic findings on upper endoscopy have a limited negative predictive value for the presence of CGI. Upper endoscopic findings in 55 CGI patients

W2022 Upper Endoscopic Findings in Patients with Chronic Gastrointestinal Ischemia

Background Upper gastrointestinal endoscopy is often used as diagnostic method for chronic gastrointestinal ischemia (CGI). This is based on the assumption that patients with symptomatic CGI have typical gastroduodenal abnormalities like erosions/ulcerations and/or paleness. However, little is known about the true prevalence and character of specific gastroduodenal lesions in patients with CGI. This study therefore aimed to investigate upper endoscopic findings in patients with well-defined CGI. Methods Prospectively, consecutive patients suspected for CGI were included. All patients underwent a standard diagnostic work-up existing of gastroduodenoscopy, gastric and jejunal 24 hour tonometry (TM) enabling mucosal CO2measurements both in fasting and post-prandial state, and CT or MR abdominal angiography for defining abdominal arterial stenosis. All diagnostic results were discussed in a multidisciplinary team and a consensus diagnosis on presence or absence of CGI was made. Only patients diagnosed with CGI were included for this study. Endoscopic findings were scored in the stomach, bulbus, and duodenum. They were differentiated in mucosal erythema, edema, paleness, and breaks (erosions/ulcers). Results In 2 years time, 144 patients were analyzed for possible CGI. CGI was diagnosed in 76 patients (53%): 25 males, mean age 62 (17-86) years. Singleand multivessel disease was diagnosed in 43 and 33 patients respectively. Upper endoscopy was performed in 55 patients. Endoscopic pathological findings were found in 34 (62%) of those 55 patients (Table). Typical ischemic lesions (erosions/ ulcerative lesions and/or paleness) were only found in 19 (25%) patients. Mucosal erythema and edema were found most frequently, and were mostly seen in the stomach, in 22 and 13 patients respectively. Conclusions CGI patients often present with non-specific upper endoscopic pathology, only a minority of patients show mucosal breaks and/or paleness during upper gastrointestinal endoscopy. No differences in prevalence and character of pathological findings existed between patients with single versus multiple vessel CGI. These data show that normal endoscopic findings on upper endoscopy have a limited negative predictive value for the presence of CGI. Upper endoscopic findings in 55 CGI patients

Acute Gastroduodenal Lesions in Patients with Venous Thromboembolism: Identification of Patients at Risk

The prime complication of heparin therapy is bleeding, and the gastrointestinal tract is the most common site of bleeding in patients treated with heparin. We recently reported that gastroduodenal lesions are common in patients admitted because of acute venous thromboembolism, and now we present our experience in a larger series of patients. The aims of the study were to try to validate our previous findings and to identify clinical factors that could increase the likelihood of having an acute, potential bleeding lesion in the gastroduodenal tract. Upper gastrointestinal endoscopy was performed on admission in 155 consecutive patients with acute venous thromboembolism (118 with deep vein thrombosis, 37 with pulmonary embolism). Acute lesions (both peptic ulcers and diffuse erosions) were found in 19 of 118 patients (16 percent) with venous thrombosis, and in 14 of 37 patients (38 percent) with pulmonary embolism (p = 0.005). When only patients with pulmonary embolism were considered, lesions were more commonly found in men, and in patients with severe hypoxemia on admission. When considered overall, only the timing of endoscopy was statistically significant; acute lesions were more commonly found when endoscopy was performed early after admission. No significant differences were found in terms of age, sex, smoking habits, alcohol intake, concomitant drug ingestion, comorbid diseases, or previous history of ulcer. The very high incidence of upper GI tract lesions in these patients will have long-term diagnostic/therapeutic implications which cannot be ignored. Who should receive prophylactic H2 blockers and for how long remains to be determined.

Misoprostol in the Treatment and Prevention of Nonsteroidal Anti-Inflammatory Drug-Induced Gastrointestinal Mucosal Injury

Three studies are discussed with regard to the efficacy of misoprostol, a synthetic prostaglandin Et analogue, in the treatment and prevention of NSAID-induced gastroduodenal lesions in patients with rheumatoid arthritis and osteoarthritis. ln the treatment study, misoprostol was found to be highly effective in healing aspirin-induced gastroduodenal lesions, eg, intramucosal hemorrhage, erosions, and gastric and duodenal ulcers, in patients with rheumatoid arthritis continuing NSAID therapy. Treatment successes were reported in 60% ( week 4) and 70% ( week 8) of patients receiving misoprostol compared with 31% (week 4) and 25% (week 8) of patients receiving placebo (P=0.0001). Furthermore, misoprostol did not adversely affect anti-inflammatory and analgesic efficacy of aspirin in rheumatoid arthritis. ln one prevention study, misoprostol co-administered with therapeutic doses of NSAIDs, was found co be safe and effective in preventing NSAID-induced gastric ulcers in osteoarthritic patients. At week 12, 94% of patients on 100 μg misoprostol qid were ulcer-free versus 99% on 200 μg misoprostol qid and 78% on placebo (P&lt;0.001 ). In a second prevention study the preliminary analysis of data showed the superior efficacy of misoprostol compared to sucralfate in preventing NSAID-induced gastric ulcers. New findings from research on prostaglandin analogues suggest that they may have therapeutic applications beyond the prevention and treatment of NSAID-induced gastrointestinal mucosal damage. Misoprostol may protect against-NSAID induced renal dysfunction, may reduce the damage to cartilage that has been associated with some NSAIDs, and is associated with a reduction in the incidence of rejection crises as well as with improvement in renal function in patients undergoing renal transplantation.

Misoprostol Heals Gastroduodenal Injury in Patients With Rheumatoid Arthritis Receiving Aspirin

High-dose aspirin therapy for rheumatoid arthritis is frequently associated with severe gastrointestinal injury. To explore the possibility of reversing such damage, we conducted a double-blind, multicenter study with misoprostol, a prostaglandin E1 analog, which has demonstrated mucosal protective, gastric antisecretory, and ulcer healing properties. We also studied possible interference of misoprostol with continuing aspirin treatment in the management of patients with rheumatoid arthritis. Patients with confirmed rheumatoid arthritis and endoscopically documented gastroduodenal lesions were randomly assigned to receive 200 micrograms of misoprostol four times a day (123 patients) or placebo (116 patients). Each concurrently received 650 to 1300 mg of aspirin four times a day. After eight weeks of treatment, misoprostol was statistically superior to placebo in healing gastric mucosal injury (70% vs 25%) and duodenal mucosal injury (86% vs 53%). Patients with gastric or duodenal ulcers on admission had superior ulcer healing rates with misoprostol (67% vs 26%). There was no evidence of interference with the antirheumatic properties of aspirin. Mild to moderate adverse experiences were equally noted in misoprostol and placebo groups. Misoprostol, coadministered with aspirin, is well tolerated and highly effective in healing aspirin-associated gastroduodenal lesions in patients with rheumatoid arthritis without altering the therapeutic benefits of aspirin.